The Role of the Department of Defense

During A Flu Pandemic

Lawrence Kapp
Specialist in Military Manpower Policy

Don J. Jansen
Analyst in Defense Health Care Policy

June 4, 2009

Congressional Research Service

7-5700
www.crs.gov
R40619
CRS Report for Congress
Prepared for Members and Committees of Congress
 The Role of the Department of Defense During A Flu Pandemic

Summary
A flu pandemic is a worldwide epidemic of an influenza virus. As such, the United States’
response to a flu pandemic would have both international and domestic components. Additionally,
the domestic response effort would include contributions from every governmental level (local,
state, tribal, and federal), non-governmental organizations, and the private sector. This report will
focus largely on the role of the Department of Defense (DOD) in supporting the nation’s domestic
response effort, although it will also touch on DOD’s international role.

The Department of State would lead the federal government’s international response efforts,
while the Department of Homeland Security and the Department of Health and Human Services
would lead the federal government’s domestic response. The Department of Defense would likely
be called upon to support both the international and domestic efforts. An analysis of the tasks
assigned by the National Strategy for Pandemic Influenza Implementation Plan indicates that
DOD’s role during a flu pandemic would center on the following objectives: assisting in disease
surveillance; assisting partner nations, particularly through military-to-military assistance;
protecting and treating US forces and dependents; and providing support to civil authorities in the
United States

With respect to providing support to civil authorities in the United States, the types of defense
support which would likely be in greatest demand during a flu pandemic include: providing
disease surveillance and laboratory diagnostics; transporting response teams, vaccines, medical
equipment, supplies, diagnostic devices, pharmaceuticals and blood products; treating patients;
evacuating the ill and injured; processing and tracking patients; providing base and installation
support to federal, state, local, and tribal agencies; controlling movement into and out of areas, or
across borders, with affected populations; supporting law enforcement; supporting quarantine
enforcement; restoring damaged public utilities; and providing mortuary services. Note, however,
that DOD’s ability to support these requests would be limited by its national defense and force
protection responsibilities. The two principal ways in which defense support could be provided to
civil authorities are by way of an “immediate response,” or in response to a formal “request for
assistance” (RFA). Additionally, in extreme circumstances the federal government may expedite
or suspend the RFA process and initiate a “proactive federal response.”

National Guard personnel would almost certainly be involved in domestic response efforts as
members of their state militia under the control of their governor. Current DOD plans do not
anticipate federal mobilization of the National Guard or Reserves to respond to a flu pandemic.
However, these plans could be modified if circumstances warranted it (for example, if the
severity of the pandemic significantly exceeded DOD’s planning assumptions). In the event such
a federal mobilization is contemplated, an important consideration would be the impact it would
have on any response efforts that were already occurring at the state and local levels. For
example, the activation of Reserve and National Guard medical personnel may pull them out of
local hospitals where they are already engaged in the response effort, thereby undermining state
and local response efforts.

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 The Role of the Department of Defense During A Flu Pandemic

Contents
The Federal Response to a Flu Pandemic.....................................................................................1
The National Response Framework .......................................................................................1
The National Strategy for Pandemic Influenza.......................................................................2
The Role of the Department of Defense.......................................................................................3
Disease Surveillance .............................................................................................................3
Partner Nation Assistance......................................................................................................4
Protecting and Treating U.S. Forces and Dependents .............................................................5
Preparedness ...................................................................................................................5
Communications .............................................................................................................6
Medical Response ...........................................................................................................6
Defense Support of Civil Authorities .....................................................................................6
Examples of Defense Support Which Civil Authorities Might Request During a
Flu Pandemic ...............................................................................................................7
Mechanisms for Providing DSCA ...................................................................................7
The Role of the Reserves and National Guard ........................................................................... 11
The Difference Between the Reserves and the National Guard....................................... 11
Activating the Reserves for Pandemic Flu Response...................................................... 12
Activating the National Guard for Pandemic Flu Response............................................ 13
Considerations .............................................................................................................. 14

Figures
Figure 1. Assistance Request Procedures .................................................................................. 10

Contacts
Author Contact Information ...................................................................................................... 15

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 The Role of the Department of Defense During A Flu Pandemic

The Federal Response to a Flu Pandemic

A flu pandemic is a worldwide epidemic of an influenza virus. As such, the United States’
response to a flu pandemic would have both international and domestic components. Additionally,
the domestic response effort would depend upon contributions from every governmental level
(local, state, tribal, and federal), non-governmental organizations, and the private sector. This
report will focus largely on the role of the Department of Defense (DOD) in supporting the
nation’s domestic response effort, although it will also touch on DOD’s international role.

The National Response Framework

The federal response to a flu pandemic would be broadly shaped by statute and executive branch
plans and policies. Statutes such as the Robert T. Stafford Disaster Relief and Emergency
Assistance Act (the Stafford Act), the Public Health Service Act, and other public health
emergency authorities1 permit the federal government to provide various forms of assistance2 to
eligible applicants, including state and local governments, non-profit organizations and
individuals. While these statutes authorize the federal government to provide assistance, the
manner in which the array of federal agencies provide that assistance in coordination with other
levels of government, non-governmental organizations, and the private sector is guided by an
executive branch planning document known as the National Response Framework (NRF).3

The NRF “is a guide to how the Nation conducts all-hazards response.”4 Among other things, it
establishes broad lines of authority for federal government agencies to prepare for and respond to
any terrorist attack, major disaster, or other emergency (i.e., “all-hazards”). Under the NRF, the
Secretary of State is responsible for “managing international preparedness, response and recovery
activities relating to domestic incidents and the protection of U.S. citizens and U.S. interests
overseas.”5 The Secretary of Homeland Security is “the principal Federal official for domestic
incident management...[and is] responsible for coordination of Federal resources utilized in the
prevention of, preparation for, response to, and recovery from terrorist attacks, major disasters,
and other emergencies.”6 However, the Secretary of Health and Human Services (HHS) “leads all
Federal public health and medical response to public health emergencies and incidents covered by

1
For more information on the statutory authorities which might be used during a flu pandemic, see CRS Report
RL33579, The Public Health and Medical Response to Disasters: Federal Authority and Funding, by Sarah A. Lister.
2
For a description of the types of assistance which can be provided under the Stafford Act, see CRS Report RL33053,
Federal Stafford Act Disaster Assistance: Presidential Declarations, Eligible Activities, and Funding, by Keith Bea,
especially pp. 11-14. For a description of the types of assistance which can be provided under the Public Health
Emergency Act and other federal public health emergency authorities, see CRS Report RL33579, The Public Health
and Medical Response to Disasters: Federal Authority and Funding, by Sarah A. Lister, especially pp. 27-34.
3
Department of Homeland Security, National Response Framework, Washington, DC, January 2008,
http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf. For more information on the NRF, see CRS Report RL34758,
The National Response Framework: Overview and Possible Issues for Congress, by Bruce R. Lindsay. Note that the
NRF itself is derived from multiple statutes, regulations, executive orders and presidential directives. See the NRF List
of Authorities and References, available at http://www.fema.gov/pdf/emergency/nrf/nrf-authorities.pdf.
4
National Response Framework, 1.
5
National Response Framework, 26.
6
National Response Framework, 25.

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the NRF.”7 Given the centrality of public health and medical response during a flu pandemic,
HHS would be the primary response agency for the domestic response, even while DHS
coordinates the overall domestic response effort.

The role of the Department of Defense (DoD) in supporting domestic response efforts under the
NRF is potentially significant, while recognizing certain limits due to the Department’s principal
mission of national defense:

The primary mission of the Department of Defense (DOD) and its components is national
defense. Because of this critical role, resources are committed after approval by the Secretary
of Defense or at the direction of the President. Many DOD components and agencies are
authorized to respond to save lives, protect property and the environment, and mitigate
human suffering under imminently serious conditions, as well as to provide support under
their separate established authorities, as appropriate. The provision of defense support is
evaluated by its legality, lethality, risk, cost, appropriateness, and impact on readiness. When
Federal military and civilian personnel and resources are authorized to support civil
authorities, command of those forces will remain with the Secretary of Defense. DOD
elements in the incident area of operations and National Guard forces under the command of
a Governor will coordinate closely with response organizations at all levels.8

A more thorough discussion of the types of support DoD might be called upon to provide to civil
authorities, and the process whereby such support can be requested, occurs later in this report.

The National Strategy for Pandemic Influenza

While the NRF provides an “all-hazards” response framework, the federal government also has a
strategic plan which specifies in more detail precisely how it will prepare for and respond to a flu
pandemic within the context of the NRF. The National Strategy for Pandemic Influenza (hereafter
National Strategy) provides an overarching outline of how the federal government will prepare
for, detect and respond to a such an event. It is based on three “pillars”: preparedness and
communications; surveillance and detection; and response and containment. A related document,
the National Strategy for Pandemic Influenza Implementation Plan (hereafter Implementation
Plan), details the specific actions and policy decisions which will be needed to execute this
strategy and bring all the resources of the federal government to bear in a coordinated manner.
Like the NRF, it affirms that the Secretary of State would be responsible for the coordination of
the international response, the Secretary of Homeland Security would have overall responsibility
for the federal government’s response to a pandemic, and the Secretary of Health and Human
Services would be responsible for the “overall coordination of the public health and medical
emergency response during a pandemic....”9 It describes the role to the Secretary of Defense as
follows:

The Secretary of Defense will be responsible for protecting American interests at home and
abroad. The Secretary of Defense may assist in the support of domestic infrastructure and
essential government services or, at the direction of the President and in coordination with

7
Department of Homeland Security, Emergency Support Function #8 – Public Health and Medical Services Annex,
Washington, DC, January 2008, ESF 8-2, http://www.fema.gov/pdf/emergency/nrf/nrf-esf-08.pdf.
8
National Response Framework, p. 26.
9
Homeland Security Council, National Strategy for Pandemic Influenza Implementation Plan, Washington, DC, May
2006, p. 50, http://www.pandemicflu.gov/plan/federal/pandemic-influenza-implementation.pdf.

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the Attorney General, the maintenance of civil order or law enforcement, in accordance with
applicable law. The Secretary of Defense will retain command of military forces providing
support.10

Subsequently, the Implementation Plan assigns some 300 tasks to various federal agencies. For
each of these tasks, a lead federal agency is identified and, if need be, supporting agencies as
well.

The Role of the Department of Defense

A DoD analysis of the Implementation Plan identified 31 tasks which were assigned primarily to
DoD and 83 which were assigned to other agencies with DoD in a supporting role. 11 Of the tasks
assigned primarily to DoD, most were related to one of these four objectives:

• Assisting in disease surveillance

• Assisting partner nations, particularly through military-to-military assistance
• Protecting and treating US forces and dependents
• Providing support to civil authorities in the United States
Each of these general objectives is discussed in more detail below. 12

Disease Surveillance
The Department of Defense plays an important role in detecting and tracking diseases. Given the
wide dispersal of U.S. military forces around the globe, 13 the Department of Defense has long

10
National Response Framework, p. 29.
11
Office of the Assistance Secretary of Defense, Homeland Defense, Department of Defense Implementation Plan for
Pandemic Influenza, Washington, DC, August 2006, p. 20,
http://fhp.osd.mil/aiWatchboard/pdf/DoD_PI_Implementation_Plan_August_2006_Public_Release.pdf. Note that this
document is distinct from the National Strategy for Pandemic Influenza Implementation Plan. The Department of
Defense Implementation Plan for Pandemic Influenza is based on the tasks contained in the National Strategy for
Pandemic Influenza Implementation Plan.
12
The Department of Defense’s plans to meet these objectives are contained in several other documents: Department of
Defense Implementation Plan for Pandemic Influenza, CONPLAN 3351: DOD Global Response to Pandemic
Influenza, and USNORTHCOM CONPLAN 3591: USNORTHCOM Response to Pandemic Influenza. The Department
of Defense Implementation Plan “sets forth [DOD] guidance and addresses key policy issues for pandemic influenza
planning.” CONPLAN 3351 directs “planning and synchronization of DOD’s global response to a potential pandemic.”
USNORTHCOM CONPLAN 3591, a supporting plan to CONPLAN 3351, focuses on support to the “national effort in
response to a potential pandemic resulting from human-to-human transmission of an influenza virus. The two
CONPLANS are not classified, but according to the NORTHCOM legislative liaison office, DOD policy does not
permit the public release of operational plans. Nonetheless, the broad outlines of the DOD response effort can be
ascertained by reference to the higher level documents discussed previously, to the unclassified Department of Defense
Implementation Plan for Pandemic Influenza, and to an unclassified summary of the CONPLANS prepared by
USNORTHCOM.
13
DoD has personnel deployed to at least 147 countries around the world, and has a presence of over 200 personnel in
at least 21 of them. Countries which have over 200 U.S. active duty military personnel in them include: Afghanistan,
Bahrain, Belgium, Cuba (Guantanamo), Djibouti, Egypt, Germany, Greece, Honduras, Iraq, Italy, Japan, Netherlands,
Portugal, Qatar, Saudi Arabia, Serbia (includes Kosovo), South Korea, Spain, Turkey, and the United Kingdom.
Figures do not include mobilized reservists, DOD civilians, DOD contractors, or family members. Defense Manpower
Data Center, Statistical Information Analysis Division, Active Duty Military Personnel Strength by Regional Area and
(continued...)

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maintained a system for detecting infectious diseases in order to maintain intelligence on possible
threats to force readiness. DoD conducts continuous worldwide influenza surveillance at domestic
laboratories as well as at military installations around the world. More than a dozen different
DOD entities cooperate with each other, foreign militaries, and some nonmilitary organizations in
a complex arrangement that allows global surveillance of emerging infections.14 International
cooperation is important due to the rapid transmission of disease made possible by high levels of
global travel. DOD policy is designed to provide for detection capabilities at the lowest possible
organizational level. The Institute of Medicine reviewed DOD’s global influenza surveillance
network in 2007 and issued a mainly favorable assessment,15 although the Implementation Plan
required the Department of Defense to improve its capacity to detect and monitor new influenza
strains, and to enhance its ability to share information with international organizations and
agencies.16 DOD’s influenza surveillance programs actively coordinate with the Centers for
Disease Control and Prevention, Food and Drug Administration, and World Health Organization.

Partner Nation Assistance

Under the Implementation Plan, the Secretary of State is responsible for

the coordination of the international response, including ensuring that other nations join us in
our efforts to contain or slow the spread of a pandemic virus, helping to limit the adverse
impacts on trade and commerce, and coordinating our efforts to assist other nations that are
impacted by the pandemic.17

However, DoD has well-developed relationships with key leaders in many nations -- particularly
with respect to foreign military officers and defense officials – and it also has expertise and
capabilities that could be useful to the efforts of foreign governments to detect and contain a
pandemic. As such, the Implementation Plan directed DoD to conduct a number of actions, in
coordination with the Department of State and other appropriate agencies, to assist partner nation
militaries in preparing for a pandemic. Examples of this type of assistance include assessing the
preparedness and response plans of foreign militaries, validating these response plans with
military-to-military exercises, conducting training programs to improve military infection control
and case management, and assessing the capacity of foreign military labs and response teams.18
The Implementation Plan also directed DoD to support the Department of State in providing U.S.
response capabilities to international response efforts. Examples of this type of support would
include participating in investigative or technical assistance teams, or delivering countermeasures
to affected countries. 19 Additionally, if the Secretary of Defense approves a request from another

(...continued)
Country, December 31, 2008, http://siadapp.dmdc.osd.mil/personnel/MILITARY/history/hst0812.pdf.
14
For additional information, please see Department of Defense, Armed Forces Health Surveillance Center, Global
Emerging Infections Surveillance & Response System, Fiscal Year 2008 Annual Report, 2008,
http://www.geis.fhp.osd.mil/GEIS/aboutGEIS/annualreports/GEISAR08.pdf.
15
Institute of Medicine, Review of the DoD-GEIS Influenza Programs: Strengthening Global Surveillance and
Response, National Academies Press, Washington, DC, 2008.
16
See National Strategy for Pandemic Influenza Implementation Plan, actions 4.1.8.4, 4.2.2.5, 4.2.2.6, 4.2.2.7, 4.2.3.8,
4.2.3.9, 6.2.3.4, 6.2.4.3, and 6.3.4.7.
17
National Strategy for Pandemic Influenza Implementation Plan, p. 29.
18
See National Strategy for Pandemic Influenza Implementation Plan, actions 4.1.1.3, 4.1.2.6, 4.2.3.10.
19
See National Strategy for Pandemic Influenza Implementation Plan, actions 4.3.1.3, 4.3.1.5, 4.3.3.1.

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federal agency for such support or if the President so directs, DoD may support containment
operations or stability operations in another nation.20

Protecting and Treating U.S. Forces and Dependents

In responding to an influenza pandemic, the Department of Defense would place a very high
priority on protecting DoD personnel, including uniformed military servicemembers, DoD
civilian employees, and contractors performing critical roles. 21 The rationale for this is based on
the national security implications of a virus disabling a sizable proportion of the DoD workforce.
For example, an influenza pandemic could conceivably render naval ships unable to perform
missions, shut down training and support activities on major bases, seriously degrade security at
critical sites, and break the supply chain that sustains forward deployed forces. The
Implementation Plan states:

The primary responsibility of DOD is to preserve national security by protecting American

forces, maintaining operational readiness, and sustaining critical military missions. DOD’s
first priority with respect to protecting human health will be to ensure sufficient capability to
provide medical care to DOD forces and beneficiaries. DOD can provide medical, public
health, transportation, logistical, communications, and other support [to non-DOD
beneficiaries] consistent with existing legal authorities and to the extent that DOD’s National
Security preparedness is not compromised.22

In addition to conducting world-wide surveillance of potential disease threats (discussed

previously), DoD protects its workforce through preparedness, communication, and medical
response.

Preparedness
Preparedness includes acquisition and prepositioning of vaccines, medicines, and other supplies.
For example, DOD reports having 8.2 million treatment courses of Tamiflu on hand. With respect
to the current H1N1 flu outbreak, testing to date shows the virus is susceptible to the antivirals23
Tamiflu and Relenza. However, over time, increasing resistance is a possibility. DOD also reports
that it has an 80-day supply of personal protective equipment (gowns, masks, and gloves) for
medical providers. Although at this time there is no vaccine24 available for H1N1, DOD has
policies and organizations, such the Army’s Military Vaccine Agency (MILVAX), in place to issue
vaccination policies and guidance and to coordinate with the Department of Health and Human
Services in acquiring vaccines when they are available. In general, it is DOD policy to follow the
20
Department of Defense Implementation Plan for Pandemic Influenza, p. 17
21
“DOD’s first priority, in the event of a flu pandemic, will be to ensure sufficient personnel, equipment, facilities,
materials and pharmaceuticals to provide the highest possible level of health support to DOD forces, civilian personnel,
and beneficiaries as well as to protect and preserve DOD's worldwide operational effectiveness.” Department of
Defense Implementation Plan for Pandemic Influenza, Annex C: Force Health and Protection, p. 62. The Department of
Defense workforce is made up of approximately 1.4 million active duty personnel, one million members of the Ready
Reserve, 700,000 civilians and contractors who perform an estimated 1.5 million work year equivalents. Additionally,
there are roughly 2.3 million active duty family members who are eligible for access to military medical care, along
with 5.3 million retirees and retiree family members.
22
National Strategy for Pandemic Influenza Implementation Plan , p. 115.
23
Antiviral drugs are a class of medication used specifically for treating infections caused by viruses.
24
A vaccine is a biological preparation that improves immunity to a particular disease.

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immunization recommendations of the Centers for Disease Control and Prevention and its
Advisory Committee for Immunization Practices consistent with requirements and guidance of
the Food and Drug Administration and consideration for the unique needs of military settings and
exposure risks.

Communications
With respect to communications, DOD has developed both passive and active channels for
disseminating relevant guidance and information. DOD established a medical “watch board” web
site (http://fhp.osd.mil/aiWatchboard/dodleadership.jsp) to provide the up-to-date information and
links to other sources of information. The Assistant Secretary of Defense for Health Affairs
maintains three other websites tailored to different audiences with the DOD community.

DOD’s influenza pandemic policies anticipate the need for flexibility as circumstances change,
such that, for example, if a shortage of antiviral medications were encountered, treatment priority
categories could be identified and implemented. 25 On April 24, 2009, NORTHCOM issued a
force health protection advisory including guidance for North America that included general
influenza risk reduction measures. 26

Medical Response
If a servicemember or other eligible person becomes infected, the military health system operates
both direct care and purchased care systems through which he or she may receive treatment. The
direct care system’s primary objectives are first, to support the national security mission and
second, to provide beneficiaries enrolled in the Tricare Prime and Tricare Plus programs with
primary care at military treatment facilities. The purchased care system, consisting of three
regional Tricare contract providers, allows beneficiaries using the Tricare Standard program to
access care from civilian providers.

Defense Support of Civil Authorities

During a serious flu pandemic, there is a strong possibility that local, state, and federal responders
will request assistance from the Department of Defense. DoD has a broad range of capabilities
that could be useful to civil authorities in emergency situations, including transportation assets,
medical personnel and supplies, security forces, and communications equipment The NRF and
the Implementation Plan refer to this type of assistance as Defense Support of Civil Authorities
(DSCA), while DoD often refers to it as Civil Support (CS) or Military Assistance to Civil
Authorities (MACA).27 This report will follow the NRF terminology unless otherwise specified.

25
S. Ward Casscells, MD, Department of Defense Policy for Prioritizing Delivery of Medical Care during Pandemics
and Other Public Health Emergencies of National Significance, Assistant Secretary of Defense(Health Affairs), HA
Policy 08-010, September 1, 2008, http://www.health.mil/Content/docs/pdfs/policies/2008/08-010.pdf.
26
USNORTHCOM Joint Operations Center, USNORTHCOM Force Health Protection 09-114 Swine Influenza, April
24, 2009, http://fhp.osd.mil/aiWatchboard/pdf/NORTHCOM%20Force%20Health%20Protetion%20MSG%20-
%20Swine%20Influenza.pdf.
27
There are technical distinctions between these terms as used by DoD. See the entries for “Defense Support of Civil
Authorities,” “Military Support to Civil Authorities,” and “Civil Support” in Department of Defense, JP 1-02,
Department of Defense Dictionary of Military and Associated Terms, Washington, DC, as amended through March 17,
(continued...)

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Examples of Defense Support Which Civil Authorities Might Request During

a Flu Pandemic
The types of defense support which would likely be in greatest demand during a flu pandemic are
contained in the Implementation Plan and the NRF’s Emergency Support Function (ESF) # 8,
Public Health and Medical Response Annex .28 A review of these documents indicates an
anticipated demand for the types of support from DOD listed below. Note, however, that DOD’s
ability to support these requests would be limited by its national defense and force protection
responsibilities.

• providing disease surveillance and laboratory diagnostics

• transporting response teams, vaccines, medical equipment, supplies, diagnostic
devices, pharmaceuticals and blood products
• treating patients
• evacuating the ill and injured
• processing and tracking patients
• providing base and installation support to federal, state, local, and tribal agencies
• controlling movement into and out of areas, or across borders, with affected
populations
• supporting law enforcement
• supporting quarantine enforcement
• restoring damaged public utilities
• providing mortuary services

Mechanisms for Providing DSCA

The two principal ways in which such support could be provided are by way of an “immediate
response,” or in response to a formal “request for assistance” (RFA). Additionally, in extreme
circumstances the federal government may expedite or suspend the RFA process and initiate a
“proactive federal response.”

Immediate Response
Certain defense officials can provide DSCA in a limited manner using “immediate response”
authority. Immediate response authority enables local military commanders and certain DOD
civilians to act immediately “to save lives, prevent human suffering, or mitigate great property

(...continued)
2009, http://www.dtic.mil/doctrine/jel/new_pubs/jp1_02.pdf.
28
ESF #8 “provides the mechanism for coordinated Federal assistance to supplement State, tribal, and local resources
in response to a public health and medical disaster, potential or actual incidents requiring a coordinated Federal
response, and/or during a developing potential health and medical emergency.” Emergency Support Function #8 –
Public Health and Medical Services Annex, ESF#8-1

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damage” when they receive a request from a civil authority and “[w]hen such conditions exist and
time does not permit prior approval from higher headquarters.”29 Assistance provided under this
authority might include providing medical care, restoring critical public services, distributing
food and other supplies, and disposing of the dead. However, commanders using this authority are
obligated to seek approval or authorization through their chain of command as soon as possible. It
is therefore likely that this authority would only be used if the onset of a flu pandemic were
abrupt and unanticipated. Providing DSCA in this manner would typically be limited to the fairly
short period of time, until a more systematic federal response could be undertaken within the
context of the NRF and the Implementation Plan. Once that occurred, support would normally be
provided in response to an RFA.

Responding to a Request for Assistance

One of the tenets of the NRF is “tiered response.” Tiered response means that the response to any
emergency should be “managed at the lowest possible jurisdictional level and supported by
additional capabilities when needed.”30 This means that response efforts typically begin at the
local level and, if the need arises, support is requested from neighboring jurisdictions, the state, or
the federal government. The federal government has a number of broad statutory authorities it can
use to assist state, local, and tribal governments in responding to such requests.31 This assistance
typically takes the form of funding, personnel, equipment, supplies, services, facilities,
information and technical assistance.

In the event of a flu pandemic, the federal government would establish one or more operational
response centers to coordinate the federal response. 32 State, local, or tribal entities would submit
their RFAs to the designated response center. The lead federal agency – either HHS for public
health and medical response requests or DHS for all other requests -- would receive these
requests and attempt to fill them by drawing on the full range of assets and capabilities available
throughout all the federal agencies. Those RFAs which needed DoD assets would be forwarded to
the Defense Coordinating Officer (DCO), who serves as the single point of contact for DOD
resources for other government agencies in the center. The DCO would be responsible for
“processing requirements for military support, forwarding mission assignments to the appropriate
military organizations through DOD-designated channels, and assigning military liaisons, as
appropriate, to activated [Emergency Support Functions].”33

The DCO would submit any such requests to the Office of the Secretary of Defense, where they
would be evaluated by the Assistant Secretary of Defense for Homeland Defense and Americas’
Security Affairs (ASD/HD & ASA) according to the following criteria: legality, readiness,
lethality, risk, cost, and appropriateness.34 This would be done on an expedited basis and then

29
Department of Defense, Department of Defense Directive 3025.1, “Military Support to Civil Authorities,”
Washington, DC, January 15, 1993, para. 4.5, http://www.dtic.mil/whs/directives/corres/pdf/302501p.pdf.
30
National Response Framework, 10.
31
See discussion in previous section entitled “The National Response Framework”.
32
Examples of these response elements include National Response Coordination Centers (NRCC), Regional Response
Coordination Centers (RRCC), Joint Field Offices (JFO), and Disaster Recovery Centers (DRCs). See “Overview of
Stafford Act Support to the States,” available at http://www.fema.gov/pdf/emergency/nrf/nrf-stafford.pdf.
33
National Response Framework, 68.
34
Department of Defense, Joint Publication 3-28, Civil Support, Washington, DC, September 2007, pp. II-3 to II-4,
http://www.dtic.mil/doctrine/jel/new_pubs/jp3_28.pdf.

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forwarded to the Secretary of Defense for approval. The Secretary of Defense has the principal
authority for approving DSCA requests. His office retains approval authority for all requests for
assistance from civilian agencies and retains control of all DOD assets provided. 35 Once the
Secretary of Defense approved the requests, they would be forwarded to the Joint Director of
Military Support within the Joint Staff, who in turn would provide the appropriate orders to
NORTHCOM. (See Figure 1).

U.S. Northern Command (NORTHCOM) has the operational responsibility for providing DSCA
for most of the United States. It carries out the DSCA missions approved by the Secretary of
Defense with forces assigned as required from all the armed services, typically through the
creation of a joint task force. 36 Although NORTHCOM has had an Army brigade assigned to it
since October 1, 2008, it probably would not be used to conduct DSCA missions in support of a
pandemic flu response. 37 Rather, additional forces would be assigned to NORTHCOM to conduct
approved DSCA missions. These additional forces could include units from multiple military
services and could include activated members of the National Guard and Reserve. Note, however,
that National Guard forces remain under the control of their respective governors unless ordered
into federal service. Current DOD plans do not anticipate the mobilization of Reserve or National
Guard personnel.38 This topic is discussed in more detail later in the report.

35
In practice, the Office of the Assistant Secretary of Defense for Homeland Defense and Americas’ Security Affairs
(ASD/HD & ASA) is delegated supervisory responsibility of the DSCA mission area and coordination with the
Department of Homeland Security. Within the DOD Joint Staff, DSCA responsibilities reside with the Joint Director of
Military Support.
36
DSCA for incidents in Hawaii and the Pacific territories is provided by U.S. Pacific Command.
37
The brigade assigned to NORTHCOM is part of a specially trained force for responding to chemical, biological,
radiological, nuclear, and high yield explosive [CBRNE] incidents. According to one NORTHCOM official, it
probably would not be used to support DSCA missions during a flu pandemic as its capabilities likely would not match
up well with the expected requests for assistance. Additionally, its use for this purpose might negatively impact the
unit’s ability to respond to a terrorist attack.
38
Author’s conversations with NORTHCOM and National Guard Bureau officials. With respect to the National Guard,
this only refers to federal mobilization. In the event of a flu pandemic, National Guard personnel will very likely be
called to duty by their state governors. See “Activating the National Guard for Pandemic Flu Response” later in this
report.

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Figure 1. Assistance Request Procedures

Source: Department of Defense, Joint Publication 3-28, Civil Support, September 2007, II-4

Proactive Federal Response

The NRF provides for a proactive federal response to a “catastrophic incident.”39 If a flu
pandemic were severe enough – that is, if it caused extraordinary levels of death or illness which
had severe societal impacts -- it could qualify as a catastrophic incident. A proactive response
would allow for the prepositioning of federal assets in anticipation of state, local, or tribal
requests for assistance; it would also permit the federal government40 to take charge of
coordinating the response if the affected state, local, or tribal governments were unable to do so.41
Key guidelines for a proactive federal response are quoted below:

39
“A catastrophic incident, as defined by the NRF, is any natural or manmade incident, including terrorism, that results
in extraordinary levels of mass casualties, damage, or disruption severely affecting the population, infrastructure,
environment, economy, national morale, and/or government functions. A catastrophic incident could result in sustained
nationwide impacts over a prolonged period of time; almost immediately exceeds resources normally available to State,
tribal, local, and private-sector authorities in the impacted area; and significantly interrupts governmental operations
and emergency services to such an extent that national security could be threatened.” Department of Homeland
Security, National Response Framework – Catastrophic Incident Annex, November 2008, p. CAT-1,
http://www.fema.gov/pdf/emergency/nrf/nrf_CatastrophicIncidentAnnex.pdf .
40
As discussed previously, the overall federal effort would be led by the Secretary of Homeland Security with the
Secretary of Health and Human Services leading the public health and medical response.
41
“Where State, tribal, or local governments are unable to establish or maintain an effective incident command
structure due to catastrophic conditions, the Federal Government, at the direction of the Secretary of Homeland
Security, may establish a unified command structure, led by the Unified Coordination Group (UCG), to save lives,
protect property, maintain operation of critical infrastructure/key resources (CIKR), contain the event, and protect
national security. The Federal Government shall transition to its role of coordinating and supporting the State, tribal, or
local government when they are capable of reestablishing their incident command.” Catastrophic Incident Annex ,
CAT-1.

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 The Role of the Department of Defense During A Flu Pandemic

•The primary mission is to save lives, protect property and critical infrastructure, contain the
event, and protect the national security.

•Standard procedures outlined in the NRF regarding requests for assistance may be expedited
or, under extreme circumstances, temporarily suspended in the immediate aftermath of an
incident of catastrophic magnitude, pursuant to existing law.

•Pre-identified Federal response resources are mobilized and deployed, and, if required,
begin emergency operations to commence life-safety [sic] activities.

•Notification and full coordination with States occur, but the coordination process should not
delay or impede the rapid mobilization and deployment of critical Federal resources.42

As indicated by the above, if a flu pandemic were severe enough to qualify as a catastrophic
incident, the DoD response could be anticipatory in nature. This anticipatory response would
likely conform to the general requirements contained in the NRF Catastrophic Incident Annex,
which specifies that DoD would be expected to “provide capabilities in the following support
categories: aviation, communication, defense coordinating officer/defense coordinating element,
medical treatment, patient evacuation, decontamination, and logistics.”43 If possible, the standard
RFA process would be used with DHS or HHS submitting requests to DoD. However, this
process could be expedited or even temporarily suspended in certain circumstances. 44

The Role of the Reserves and National Guard

The Difference Between the Reserves and the National Guard
Although the term “reserves” is often used as a generic term to refer to all members of the seven
individual reserve components, there is an important distinction between the five reserve
components which are purely federal entities (the Army Reserve, Navy Reserve, Marine Corps
Reserve, Air Force Reserve, and Coast Guard Reserve) and the two reserve components which
are both federal and state entities (the Army National Guard and the Air National Guard). In this
context, the purely federal reserve components are sometimes referred to collectively as the
Reserves, while the dual federal/state reserve components are referred to collectively as the
National Guard.

The Reserves are of comparatively recent origin, having all been established in the 20th century.
They were organized under Congress’ constitutional authority “to raise and support Armies” and
“to provide and maintain a Navy.”45 The National Guard has a much longer historical pedigree. It
is descended from the colonial era militia46 which existed prior to the adoption of the

42
Catastrophic Incident Annex, CAT-6.
43
Catastrophic Incident Annex, CAT 6-7. Note that these are the types of support that have been anticipated in
response to a catastrophic incident, generally speaking. The previous section entitled “Examples of Defense Assets
Which Civil Authorities Might Request During a Flu Pandemic” addresses the types of support that might specifically
be needed during a flu pandemic.
44
Catastrophic Incident Annex, CAT 6.
45
U.S. Constitution, Article 1, Section 8, clauses 12 and 13.
46
The colonial militia, which was derived from a longstanding English tradition and which required every able bodied
free male (though Native Americans and free blacks were frequently excluded) to participate in the common defense of
(continued...)

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Constitution. The Constitution does, however, contain provisions that recognize the existence of
the militia and that give the federal government a certain amount of control over it.47

Unlike the Reserves, which are exclusively federal organizations, the National Guard is usually
both a state and a federal organization. The National Guard of the United States is made up of 54
separate National Guard organizations: one for each state, and one each for Puerto Rico, Guam,
the U.S. Virgin Islands, and the District of Columbia. While the District of Columbia National
Guard is an exclusively federal organization and operates under federal control at all times, the
other 53 National Guards operate as state or territorial organizations most of the time. In this
capacity, each of these 53 organizations is identified by its state or territorial name (e.g., the
California National Guard or the Puerto Rico National Guard), and is controlled by its respective
governor. Due to their dual federal and state role, National Guardsmen can be called to duty in
several different ways, which will be discussed later in this report.

Activating the Reserves for Pandemic Flu Response

Current DOD plans do not anticipate mobilizing the Reserves to respond to a flu pandemic.48
However, these plans could be modified if circumstances warranted (for example, if the severity
of the pandemic significantly exceeded DOD’s planning assumptions).

Members of the federal reserves are always activated under Title 10 of the U.S. Code. Therefore,
they always operate under the control of the President, receive federal pay and benefits, and are
subject to the Posse Comitatus Act49 in the same way that active duty military personnel are.
There are a number of statutory authorities that can be used to activate members of the reserves,
but the one most likely to be used in a flu pandemic would be 10 USC 12302. 50 This authority

(...continued)
his town or locality, was the backbone of colonial military power. Gradually, as the colonial population grew and
military threats waned, a distinction arose between the unorganized militia (those members of the militia who were
potentially liable for military service but who did not actively participate in military training) and the organized militia
(those members of the militia who regularly trained for war and who responded first to military threats). Today, the
U.S. Code still recognizes the militia as consisting of “all able-bodied males at least 17 years of age and...under 45
years of age who are, or who have made a declaration of intention to become, citizens of the United States and of
female citizens of the United States who are members of the National Guard.” (10 U.S.C. § 311.) This provision of the
law further divides the militia into the organized militia and the unorganized militia, and declares the National Guard
and the Naval Militia to be the organized militia. At present New York, New Jersey, Ohio and Alaska have active
Naval Militias.
47
See U.S. Constitution, Article I, Section 8, clauses 15 and 16, and Article II, Section 2, clause 1.
48
See footnote 38
49
The Posse Comitatus Act (18 USC § 1385), along with other related laws and administrative provisions, prohibits the
use of the military to execute civilian laws unless expressly authorized by the Constitution or an act of Congress.
Congress has made a number of exceptions to the act which permit military involvement in law enforcement. For
example, Congress has enacted a number of statutes which authorize the President to use military forces to suppress
insurrections and domestic violence (10 USC § 331-335). If these statutes were to be invoked, the President could use
active or reserve components to put down a rebellion or to control domestic violence. Another important exception
relates to the Coast Guard, which Congress has vested with broad law enforcement authority. Under these statutory
provisions, the Coast Guard and Coast Guard Reserve can participate in the enforcement of maritime, customs, and
certain other federal laws. For more information on the Posse Comitatus Act, see CRS Report RS20590, The Posse
Comitatus Act and Related Matters: A Sketch, by Jennifer K. Elsea, and CRS Report RS22266, The Use of Federal
Troops for Disaster Assistance: Legal Issues, by Jennifer K. Elsea and R. Chuck Mason.
50
The principal statutes for activating members of the reserve component are 10 USC § 12301(a), 12301(b), 12301(d),
12302, and 12304. 10 U.S.C. § 12301(a) could be used if the Congress declared a national emergency; however, the
(continued...)

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may be used “in time of national emergency declared by the President...or when otherwise
authorized by law,” and permits the President to involuntarily activate up to one million members
of the Ready Reserve for up to 24 consecutive months.

Activating the National Guard for Pandemic Flu Response

National Guard personnel would almost certainly be involved in state efforts to respond to a flu
pandemic as members of their state militia under the control of their governor. Current DOD
plans do not anticipate calling the National Guard into federal service to respond to a flu
pandemic. 51 However, as with the case of the federal reserves, these plans could be modified if
circumstances warranted it. DOD policy guidelines currently specify that, if Reserve Component
medical personnel are required to respond to a flu pandemic, the military services are to “use
[federal] Reserve forces first, leaving National Guard forces to be available to meet their state-
based missions.”52

Members of the National Guard can be activated under state law, under Title 32 of the U.S. Code,
and under Title 10 of the U.S. Code. Depending on which authority it used, the duty status of
National Guard members is characterized as State Active Duty, Title 32 status, and Title 10 status.
A brief discussion of each status is provided below.

State Active Duty

Normally, the National Guard operates under the control of state and territorial governors. As part
of a state-level response to a flu pandemic, governors could order their National Guard personnel
to perform full-time duty under state law. This is commonly referred to as “state active duty.”53 In
this state capacity, National Guard personnel operate under the control of their governor, are paid

(...continued)
benefit of using this authority as opposed to 10 USC § 12302 is limited given that the latter authority is broad enough to
permit the activation of nearly the entire Ready Reserve force structure continuously for a period of two years; although
12301(a) would provide access to the Retired Reserve where 12302 would not. Other authorities would likely be of
limited utility or not applicable in the event of a flu pandemic. Activations under 10 U.S.C. § 12301(b) are limited to 15
days and, for National Guard personnel, require the consent of the affected governor. 10 U.S.C. § 12301(d) permits
voluntary activation of reserve component personnel, but not involuntary activation, and also requires the consent of
the affected governor for National Guard personnel. Finally, the President may activate reserve component personnel
under 10 U.S.C. § 12304 if he determines it necessary “to augment active forces for any operational mission”; however
the statute prohibits the President from calling units or members to active duty to perform duties related to repelling
invasion, suppressing insurrection, enforcing laws or “providing assistance to either the Federal Government or a State
in time of a serious natural or manmade disaster, accident, or catastrophe.” While the statute makes an exception to this
latter prohibition for certain emergencies related to terrorist attacks and weapons of mass destruction, it appears that
responding to a flu pandemic would fall within the prohibition.
51
See footnote 38.
52
David S.C. Chu, Under Secretary of Defense for Personnel and Readiness, Memorandum for Secretary of the Army,
Secretary of the Navy, and Secretary of the Air Force, Department of Defense, “Mobilization of Reserve Component
Medical Support Personnel Supporting the Local Medical Infrastructure during an Influenza Pandemic,” Washington,
DC, November 18, 2008, p. 1, http://fhp.osd.mil/aiWatchboard/pdf/RC_MED_PI_Policy(1108).pdf.
53
Historically, this authority has been used most frequently in response to natural disasters such as hurricanes,
earthquakes, forest fires, floods, etc. It has also been used to quell domestic violence and to control or disperse crowds.
Additionally, in the aftermath of the September 11 terrorist attacks, a number of governors called up members of the
National Guard to protect critical infrastructure in their states, such as nuclear power plants, water treatment facilities,
and bridges from potential terrorist attacks.

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according to state law, can assist civil authorities in a wide variety of tasks,54 and are not subject
to the restrictions of the Posse Comitatus Act (that is, they can perform law enforcement
functions).

“Title 32” Status

Another way in which National Guard personnel can be activated and remain under the control of
their governor is under the authority of 32 U.S.C. 502(f). This provision of federal law provides
that “a member of the National Guard may...without his consent, but with the pay and allowances
provided by law...be ordered to perform training or other duty in addition to [inactive duty for
training or annual training].” The advantage of using this authority is that the National Guard
personnel called will receive federal pay and benefits and are entitled to certain legal protections55
as though they were in federal service, but they remain under the control of their governor and are
therefore not subject to the restrictions of the Posse Comitatus Act. This is the provision of law
which was used to provide federal pay and benefits to the National Guard personnel who
provided security at many of the nation’s airports in the aftermath of the terrorist attacks of
September 11, 2001. It has also been used to respond to major disasters such as Hurricane Katrina
in 2005.

Federal Status
National Guard personnel can also be activated in a purely federal status. The authorities used to
do this include all of the Title 10 authorities discussed in footnote 50. When in this federal status,
National Guard personnel serve under the control of the President, receive federal pay and
benefits, and are subject to the Posse Comitatus Act in the same way that active duty military
personnel are. National Guard personnel can also be called into federal service under 10 USC
331-335 and 12406.56 If called up under one of these authorities, National Guard personnel would
operate under the control of the President, receive federal pay and benefits, and could perform
law enforcement duties.

Considerations
When considering the federal activation of the Reserves and National Guard, one important
consideration is the impact this would have on state, local, or tribal response efforts that are
already ongoing. For example, the activation of Reserve and National Guard medical personnel
may pull them out of local hospitals where they are already engaged in the response effort,

54
For example, delivering supplies, providing medical assistance, restoring public utilities, and providing security.
55
See CRS Report RL30802, Reserve Component Personnel Issues: Questions and Answers, by Lawrence Kapp, pp.
17-20.
56
10 USC § 331-335 (The Insurrection Act) allows the President to call the militia (which includes the National Guard)
into federal service for certain purposes, including the suppression of insurrection against a state government, at the
request of that government (10 U.S.C. § 331), the enforcement of federal laws and suppression of rebellion against the
authority of the United States (10 U.S.C. §332), and the prevention of interference with state and federal laws, if that
interference deprives a class of people of rights, privileges, immunities, or protections named in the Constitution (10
U.S.C. § 333). 10 U.S.C. § 12406 permits the President to call members and units of the National Guard into federal
service to repel invasion, suppress rebellion, or execute the laws of the United States; orders for this latter type of call
up must be transmitted through the appropriate governor.

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thereby undermining state and local response efforts.57 Such activations are a particular concern
with respect to National Guard personnel, who often constitute a large portion of a state’s
emergency response force. Another important factor to consider when federalizing National
Guard forces is the impact of the Posse Comitatus Act. While they remain in a state status (either
state active duty or Title 32 status), National Guard personnel are not covered by the Act and
therefore are a valuable tool for state governors in maintaining public order. Federalization of the
National Guard generally brings them under the restrictions of the Act and thereby limits their
utility for law enforcement purposes.58

Author Contact Information

Lawrence Kapp Don J. Jansen

Specialist in Military Manpower Policy Analyst in Defense Health Care Policy
lkapp@crs.loc.gov, 7-7609 djansen@crs.loc.gov, 7-4769

57
DOD has taken this into account with a policy memorandum entitled “Mobilization of Reserve Component Medical
Personnel Supporting Local Medical Infrastructure during an Influenza Pandemic.” See footnote 52.
58
See, however, the discussion of 10 USC 333-335 and 10 USC 12406 in footnote 56.

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